Report: Black women in Texas face the greatest risk from pregnancy related death

Group's rate of pregnancy-related deaths similar to that of many Third World nations

Black women bear the greatest risk for pregnancy-related death in Texas by far, according to a much-awaited new report, commissioned because the state rate resembles that of many Third World countries.

The report, which follows the publication of a national study that found Texas' maternal mortality rate has doubled since 2011, ranked heart conditions, overdose by legal or illegal drugs and high blood pressure of pregnancy as the leading causes of such deaths.

"This confirms what we feared - that many of these deaths could be prevented," said state Rep. Armando Walle, D-Houston, the House author of the 2013 bill that created a Department of State Health Services maternal mortality task force and charged it with producing biennial reports and recommendations. "It's a travesty that this is happening."

In 2011 and 2012, the years studied in the report, black women accounted for nearly 29 percent of all maternal deaths, even though they gave birth to only 11 percent of all babies. In comparison, white women accounted for 38 percent of deaths and 35 percent of births and Hispanic women, the lowest risk group, accounted for 31 percent of deaths, even though they gave birth to 48 percent of babies.

The report, released late last week, also found that mental health and substance use disorders play a significant role in maternal death. It cited providers' "repeated missed opportunities" to screen women and refer them to treatment for mental health and substance use disorders."

To address the root causes, the report called for increased access to health services, including mental and behavioral health screenings during the pre-conception and prenatal periods; and appointments to detect, monitor and manage active and latent health risks and morbidities and promote birth spacing between pregnancies, particularly the year after delivery.

'Extremely concerning'

Dr. Lisa Hollier, a Baylor College of Medicine obstetrician-gynecologist and task force chair, said "maternal mortality and maternal morbidity is going to require a multi-disciplinary approach across many different health systems and organizations." She said the issue is "extremely concerning."

Unlike last week's study in Obstetrics & Gynecology that found a dramatic spike in pregnancy-related deaths in the year since the state's drastic 2011 reduction in funding for Planned Parenthood and other women's health clinics, there were few numbers in the report. It instead focuses on the causes of Texas' rate, demographic breakdowns and suggestions for how to reverse the trend. None of that analysis was part of the Obstetrics & Gynecology study.

That study reported that from 2011 to 2015, 537 women in Texas died in pregnancy or within 42 days of delivery, up from 296 in 2007 to 2010. The rate went from 18.6 deaths per 100,000 births in 2010 to 38.7 in 2012, a 108.7 percent increase.

Photo: Maternal Mortality Report

Percentage of Texas maternal deaths and births.

Percentage of Texas maternal deaths and births.

If Texas was a nation, those numbers would rank last, behind Mexico, among 31 countries that report data to the Organization for Economic Cooperation and Development.

That the numbers were that high was a surprise to the Texas task force. They worked with data from 189 deaths in 2011 and 2012.

Photo: Maternal Mortality Report

Overdose by licit or illicit prescription drugs.

Overdose by licit or illicit prescription drugs.

Study applauded

Marian MacDorman, the University of Maryland-based lead author of the Obstetrics & Gynecology study said she applauds the Texas team for "looking into the deaths in greater detail."

"Although the Texas Department of Health study uses different methods and data sources from mine, I think we both agree that maternal mortality is a serious problem in Texas," said MacDorman. "I especially appreciate their policy recommendations for how to reduce it."

The Texas report found most of the state's maternal deaths - 60 percent - occurred between 42 days and a year after delivery. MacDorman's study identified 262 Texas deaths in the same two-year period based only on those who died within 42 days.

Walle said he is hopeful the report makes an impression on the 2017 Legislature.

"I'm not naïve to the fact we haven't expanded Medicaid, but something needs to be done to increase access to pregnant women," said Walle. "We can't keeping letting federal dollars go to other states while these women are dying."